COLORADO NURSE AIDE PRACTICE ACT

Transcription

1 COLORADO REVISED STATUTES Title 12 Professions and Occupations Article 38.1 Nurse Aides Effective July 1, 2005 DISCLAIMER: Colorado Revised Statutes are made available for public use by the Committee on Legal Services of the Colorado General Assembly through a contractual arrangement with the LexisNexis Group, which prepares and maintains the official website for the state of Colorado. The statutes are copyrighted by the state of Colorado (please see , C.R.S.). Any person wishing to reprint and distribute all or a substantial part of the statutes in either printed or electronic format must obtain prior permission of the Committee on Legal Services; permission is not required to reprint fewer than 200 sections of C.R.S. (please see , C.R.S.). LexisNexis Group customer support can be reached at

2 Table of Contents PART 1 GENERAL PROVISIONS Legislative declaration Definitions - repeal Certification - state board of nursing Application for certification - fee Application for certification by competency evaluation Application for certification by endorsement Certification by competency evaluation Approved nurse aide training programs Renewal of certification Advisory committee Medication administration advisory committee - created - department of regulatory agencies report Medication aides - training - scope of duties - rules - repeal Grounds for discipline Withholding or denial of certification Mental and physical competency of nurse aides Disciplinary proceedings - hearing officers Surrender of certificate Judicial review Exclusions Unlawful acts Injunctive proceedings Repeal of article PART 2 DIRECT CARE PROVIDER CAREER PATH PILOT PROGRAM Short title Legislative declaration Pilot program - authorization Rule-making - training - education Applicability Report Funding Repeal of part i

3 PART 1 GENERAL PROVISIONS Legislative declaration. It is declared to be the policy of the state of Colorado that, in order to safeguard life, health, property, and the public welfare of the people of the state of Colorado, and in order to protect the people of the state of Colorado against unauthorized, unqualified, and improper application of services by nurse aides in a medical facility, it is necessary that a proper regulatory authority be established. The general assembly further declares it to be the policy of this state to regulate the practice of nurse aides in medical facilities through a state agency with the power to enforce the provisions of this article. Any person who practices as a nurse aide in a medical facility without qualifying for proper certification and without submitting to the regulations provided in this article endangers the public health thereby. The general assembly hereby finds and declares that this article will meet the requirements of the federal "Omnibus Budget Reconciliation Act of 1987" Definitions - repeal. As used in this article, unless the context otherwise requires: (1) "Approved education program" means: (a) A course of training conducted by an educational or health care institution which implements the basic nurse aide curriculum prescribed and approved by the board; or (b) (I) A course of training conducted by an educational or health care institution that is approved by the board for the purposes of the direct care provider career path pilot program established in part 2 of this article. (II) This paragraph (b) is repealed, effective July 1, (2) "Board" means the state board of nursing in the division of registrations in the department of regulatory agencies, created in section (3) "Certified nurse aide" means a person who meets the qualifications specified in this article and who is currently certified by the board. Only a person who holds a certificate to practice as a nurse aide in this state pursuant to the provisions of this article shall have the right to use the title "Certified Nurse Aide" and its abbreviation, "C.N.A.". (3.5) "Home health agency" means a provider of home health services, as defined in section (6), C.R.S., that is certified by the department of public health and environment. (4) "Medical facility" means a nursing facility licensed by the department of public health and environment or home health agencies certified to receive medicare or medicaid funds, pursuant to the federal "Social Security Act", as amended, distinct part nursing facilities, or home health agencies or entities engaged in nurse aide practices as such practices are defined in subsection (5) of this section. "Medical facility" does not include hospitals and other facilities licensed or certified pursuant to section (1) (a), C.R.S. (4.5) "Nursing facility" shall have the same meaning as set forth in section (11), C.R.S. (5) "Practice of a nurse aide" or "nursing aide practice" means the performance of services requiring the education, training, and skills specified in this article for certification as a nurse aide. Such services are performed under the supervision of a dentist, physician, podiatrist, professional nurse, licensed practical nurse, or other licensed or certified health care professional acting within the scope of his license or certificate Certification - state board of nursing. (1) In addition to all other powers and duties conferred and imposed upon the board by law, the board shall have the authority to certify nurse aides to practice in the state of Colorado, and the board shall implement the provisions of this article. (2) The department of public health and environment, which is otherwise responsible for the regulation of certain medical facilities, shall, as necessary, assist the board in implementing the provisions of this article. (3) The board shall promulgate rules and regulations to carry out the purposes of this article and to ensure compliance with federal law and regulation relating to nurse aides. Effective July 1, 2005 Page 1 of 12

4 (4) The board shall maintain a registry of all certified nurse aides as well as a record of all final disciplinary action taken against persons under the provisions of this article. Such registry shall conform to all requirements of federal law and regulation. (5) (a) The board shall not issue a certificate to a former holder of a certificate whose certificate was revoked unless the applicant meets the requirements of this article, has successfully repeated an approved education program as required by the board, and has repeated and passed a competency evaluation. (b) No nurse aide certificate holder who has had a certificate revoked may apply for recertification before a one-year waiting period after such revocation. (6) Funding for the nurse aide certification program, as operated by the department of regulatory agencies, shall be provided by the federal medicaid and medicare programs. Medicaid funding shall be secured by the department of health care policy and financing and medicare funding shall be secured by the department of public health and environment. All such funding shall be forwarded to the department of regulatory agencies for its use in operating the nurse aide certification program. The departments of health care policy and financing and public health and environment shall take all reasonable and necessary steps to secure such funding from the federal medicaid and medicare programs Application for certification - fee. (1) Every applicant for certification as a nurse aide, whether qualifying by competency evaluation or by endorsement, shall submit the application on forms provided by the board. (2) (a) The application submitted pursuant to subsection (1) of this section shall be accompanied by an application fee established pursuant to section , C.R.S. (b) The board may reduce the application fee if federal funds are available. Such fee shall not be subject to the provisions of section , C.R.S. (3) (a) Repealed. (b) (Deleted by amendment, L. 2003, p. 2631, 5, effective June 5, 2003.) Application for certification by competency evaluation. (1) Every applicant for certification by competency evaluation shall pay the required application fee and shall submit written evidence that said applicant: (a) Has not committed any act or omission that would be grounds for discipline or denial of certification under this article; and (b) Has successfully completed an approved education program. (c) Repealed Application for certification by endorsement. (1) Every applicant for certification by endorsement shall pay the required application fee, shall submit the information required by the board in the manner and form specified by the board, and shall submit written evidence that said applicant: (a) Is certified to practice as a nurse aide by another state or territory of the United States with requirements that are essentially similar to the requirements for certification set out in this article and that such certification is in good standing; (b) Has not committed any act or omission that would be grounds for discipline or denial of certification under this article; (c) Has successfully completed an education program approved by the board or a nurse aide training program that meets the standards for such programs specified in this article and those standards set by the board; and (d) Has no record of abuse, negligence, or misappropriation of resident's property or any disciplinary action taken or pending in any other state or territory against such certification. (e) Repealed Certification by competency evaluation. (1) All applicants except those certified by endorsement shall be required to pass a clinical competency evaluation. Such evaluation shall be in a written or oral form and shall include the following areas: (a) Basic nursing skills; (b) Personal care skills; (c) Recognition of mental health and social services needs; Effective July 1, 2005 Page 2 of 12

5 (d) Basic restorative services; (e) Resident or patient rights. (2) Competency evaluations shall be held at such times and places as the board determines but shall be held at least four times per year Approved nurse aide training programs. (1) Except for any medical facility or program that has been explicitly disapproved by the department of public health and environment, the board may approve any nurse aide training program offered by or held in a medical facility or offered and held outside a medical facility. Such approval by the board shall be sufficient to authorize and permit the operation of such training program. (2) The curriculum content for nurse aide training must include material which will provide a basic level of both knowledge and demonstrable skills for each individual completing the program and be presented in such a manner which will take into consideration individuals with limited literacy skills. The curriculum content must include needs of populations which may be served by an individual medical facility. (3) The following topics shall be included in the curriculum: (a) Communication and interpersonal skills; (b) Infection control; (c) Safety and emergency procedures; (d) Promoting residents' and patients' independence; (e) Respecting residents' and patients' rights. (4) The training program shall be designed to enable participants to develop and demonstrate competency in the following areas: (a) Basic nursing skills; (b) Personal care skills; (c) Recognition of mental health and social services needs; (d) Basic restorative services; (e) Resident or patient rights. (5) The board or its designee shall inspect and survey each nurse aide training program it approves during the first year following such approval and every two years thereafter. Such inspection or survey may be made in conjunction with surveys of medical facilities conducted by the department of public health and environment. (6) Except as provided in this article, the board shall not require a nurse aide training program that substantially exceeds the requirements established in the federal "Omnibus Budget Reconciliation Act of 1987", as amended Renewal of certification. Each certificate to practice as a nurse aide shall be renewed or reinstated pursuant to a schedule established by the director of the division of registrations within the department of regulatory agencies and shall be renewed or reinstated pursuant to section (8), C.R.S. The director of the division of registrations within the department of regulatory agencies may establish renewal fees and delinquency fees for reinstatement pursuant to section , C.R.S. If a person fails to renew his or her certification pursuant to the schedule established by the director of the division of registrations, such certificate shall expire. Any person whose certificate has expired shall be subject to the penalties provided in this article or section (8), C.R.S Advisory committee. (1) To assist in the performance of its duties under this article, the board may designate an advisory committee that shall report to the board. Such committee shall be composed of seven members who have expertise in an area under review. One member shall be a certified nurse aide, one member shall be a licensed professional nurse who supervises certified nurse aides, one member shall represent a home health agency, one member shall represent a nursing facility, one member shall be a department of public health and environment employee, one member shall be a family member of a consumer who receives home health services or nursing facility services, and one member shall be a consumer of home health care or nursing facility services. Committee members shall not be compensated for their services but shall be reimbursed for the actual and necessary expenses in the performance of their duties from the division of registrations cash fund by the general assembly. Effective July 1, 2005 Page 3 of 12

6 (2) (Deleted by amendment, L. 93, p. 1747, 5, effective July 1, 1993.) Medication administration advisory committee - created - department of regulatory agencies report. (1) The executive director of the department of regulatory agencies shall appoint an advisory committee to assist with a study of the administration of medication by certified nurse aides in nursing facilities and through home health care agencies. (2) The advisory committee shall consist of eleven members as follows: (a) The director of the division of registrations in the department of regulatory agencies or the director's designee who is a member of or a staff person for the state board of nursing; (b) One geriatric physician licensed pursuant to article 36 of this title; (c) One pharmacist experienced in the delivery of pharmaceutical products in a health care-based setting who is licensed pursuant to article 22 of this title; (d) One advocate who represents the residents or patients in nursing facilities; (e) One home health care nurse; (f) One director of a home health agency; (g) One professional nurse who is a director of a nursing home located in an urban area; (h) One professional nurse who is a director of a nursing home located in a rural area; (i) One registered nurse who has experience teaching medication administration; (j) One registered nurse who has experience teaching the certified nurse aide program; and (k) One clinical researcher who has studied care delivery in long-term settings and in home health care. (3) The members appointed to the advisory committee pursuant to subsection (2) of this section shall not receive compensation for their services. (4) For the purposes of the review provided in sections and , C.R.S., the advisory committee shall provide input to the department of regulatory agencies regarding the issue of allowing certified nurse aides to administer medications in nursing facilities and through home health agencies. After such review, the report by the department of regulatory agencies required pursuant to section (8), C.R.S., shall include, but not be limited to, the following: (a) The benefits and risks associated with certified nurse aides serving as medication aides; (b) The effect of the use of medication aides on the level of patient care; (c) The level of experience a certified nurse aide must have in order to be considered for training as a medication aide; (d) The extent and content of classroom training and education required to be a medication aide; (e) The extent and limit to the scope of practice of a certified nurse aide who has completed training as a medication aide; and (f) The requirements for supervision for medication aides. (5) On or before September 1, 2003, the board shall provide a report to the health care task force created in section , C.R.S., regarding the status of implementation of the program for administration of medication by medication aides in nursing facilities. The report shall include the board's recommendations for any statutory changes related to training requirements, approval of training programs, scope of practice, licensing, and discipline procedures for medication aides. Based upon such report, the health care task force may recommend statutory changes to the general assembly no later than January 1, Medication aides - training - scope of duties - rules - repeal. (1) Prior to a certified nurse aide obtaining authority as a medication aide to administer medications in a nursing facility, the certified nurse aide shall meet the following prerequisites: (a) Possession of a high school diploma or a general equivalency diploma; (b) Attainment of eighteen years of age; (c) The ability to read and comprehend English; and (d) At least two thousand hours working as a certified nurse aide in a nursing facility. (2) In addition to meeting the requirements of subsection (1) of this section, an applicant for medication aide authority shall successfully complete education in the following courses that are intended to provide training and experience in medication administration: Effective July 1, 2005 Page 4 of 12

7 (a) Training courses offered in a practical nursing or licensed psychiatric technician educational program conducted by an educational or health care institution that include the following topics and numbers of credit hours: (I) Four credit hours in biology, anatomy, and physiology; (II) One credit hour in pharmacology calculations; (III) Two credit hours in pharmacology; and (IV) One credit hour in health assessment. (b) Two credit hours in a medication administration practicum at the facility where the applicant is employed under the supervision of a licensed staff member at the facility. (3) (a) After demonstrating to the board that the certified nurse aide has complied with the requirements of subsections (1) and (2) of this section, a certified nurse aide shall apply to the board to take a medication administration examination approved by the board. If the certified nurse aide passes the examination, the board shall grant the certified nurse aide authority to perform the following tasks, in a nursing facility only: (I) Measurement and documentation of vital signs prior to administering medications; (II) Administration of routinely prescribed oral medications, which the medication aide has personally prepared, including the crushing and administering of medications if such preparation is appropriate according to the manufacturer's instructions and a physician's order, and excluding coumadin and its derivatives and any scheduled drugs; and (III) Documentation of any medications personally administered by the medication aide. (b) A medication aide shall report medication administration errors immediately to his or her supervisor. (4) The board shall promulgate rules regarding the supervision requirements for a medication aide, the requirements for a registered nurse to perform a patient assessment before a medication aide administers medications to the patient, and requirements for a registered nurse to review medications to be administered by a medication aide. (5) The administration of medications by medication aides shall not alter any requirement or limitation applicable to the delegation of nursing tasks pursuant to section (6) (a) This section is repealed, effective July 1, (b) Prior to such repeal, the training, education, and functions of medication aides shall be reviewed as provided for in section , C.R.S Grounds for discipline. (1) The board may suspend, revoke, or deny any certification to practice as a nurse aide or any authority to practice as a medication aide or issue a letter of admonition upon proof that such person: (a) Has procured or attempted to procure a certificate by fraud, deceit, misrepresentation, misleading omission, or material misstatement of fact; (b) Has been convicted of a felony or has had a court accept a plea of guilty or nolo contendere to a felony. A certified copy of such conviction or plea from a court of competent jurisdiction shall be prima facie evidence of such conviction or plea. In considering discipline based on the grounds specified in this paragraph (b), the board shall be governed by the provisions of section , C.R.S. (c) (Deleted by amendment, L. 2003, p. 2633, 10, effective June 5, 2003.) (d) Has had a certification to practice as a nurse aide or to practice any other health care occupation suspended or revoked in any jurisdiction. A certified copy of the order of suspension or revocation shall be prima facie evidence of such suspension or revocation. (e) Has violated any provision of this article or has aided or knowingly permitted any person to violate any provision of this article; (f) (Deleted by amendment, L. 2003, p. 2633, 10, effective June 5, 2003.) (g) Has negligently or willfully violated any order, rule, or regulation of the board pertaining to practice or certification as a nurse aide; (h) Has verbally or physically abused a person under the care of the certified nurse aide; (i) Has habitually abused or excessively used any habit-forming drug or any controlled substance as defined in section (5), C.R.S.; (j) Has misused any drug or controlled substance, as defined in section (5), C.R.S.; (k) Has a physical or mental disability which renders him unable to practice as a certified nurse aide with reasonable skill and safety to the patients and which may endanger the health or safety of persons under his care; Effective July 1, 2005 Page 5 of 12

8 (l) Has violated the confidentiality of information or knowledge as prescribed by law concerning any patient; (m) Has misappropriated patient or facility property; (n) Has engaged in any conduct that would constitute a crime as defined in title 18, C.R.S., if such conduct relates to the person's ability to practice as a nurse aide. In considering discipline based upon the grounds specified in this paragraph (n), the board shall be governed by the provisions of section , C.R.S. (o) Has neglected a person under the care of the certified nurse aide; (p) Has willfully or negligently acted in a manner inconsistent with the health or safety of persons under his or her care; (q) Has willfully or negligently practiced as a medication aide in a manner that does not meet generally accepted standards for such practice; or (r) Has willfully or negligently violated any order or rule of the board pertaining to the practice or authorization as a medication aide. (2) Except as otherwise provided in subsection (1) of this section, the board need not find that the actions which form the basis for the disciplinary action were willful. However, the board, in its discretion, may consider whether such action was willful in determining the sanctions it imposes on the nurse aide. (3) (Deleted by amendment, L. 2003, p. 2633, 10, effective June 5, 2003.) (4) An employer of a medication aide shall report conduct that constitutes grounds for discipline pursuant to this section to the board and any disciplinary action taken by the employer against a medication aide or the resignation of a medication aide in lieu of a disciplinary action resulting from such conduct Withholding or denial of certification. (1) If the board determines that an applicant for an initial certificate to practice as a nurse aide does not possess the qualifications specified in section or , that section (1) (n) is applicable, or that there is reasonable cause to believe that the applicant has committed any of the acts set forth in section as grounds for discipline, it may deny the applicant a certificate. When the board denies a certificate, it shall comply with the following procedures: (a) The provisions of section , C.R.S., shall apply, and the board shall provide the applicant with a written statement that sets forth the basis for the board's determination. (b) If the applicant requests a hearing pursuant to section (9), C.R.S., the following shall apply: (I) An applicant whose certification has been denied on the basis of a lack of qualifications has the burden of proof to show that he possesses the qualifications required under this article. (II) For an applicant whose certification has been denied on the basis of reasonable cause to believe that grounds for discipline exist, the board has the burden of proof to show the commission of acts constituting grounds for discipline under this article. (c) If a hearing is conducted, the board shall affirm, modify, or reverse its prior determination and action in accordance with the findings resulting from such hearing. (d) If an applicant who has requested a hearing pursuant to section (9), C.R.S., fails to appear at such hearing, absent a determination by the board that there was good cause for such failure to appear, the board may affirm its prior action of withholding certification without conducting a hearing on the matter. (e) If the board withholds certification without a hearing in accordance with the provisions of this section, it shall be immune from suit concerning such withholding unless it has acted unreasonably or has failed to act in good faith Mental and physical competency of nurse aides. (1) If any certified nurse aide is determined to be mentally ill by a court of competent jurisdiction, the board shall automatically suspend his certification, and such suspension shall continue until the certified nurse aide is determined by such court to be restored to competency; duly discharged as restored to competency; or otherwise determined to be competent in any other manner provided by law. (2) (a) If the board has reasonable cause to believe that the physical or mental condition of a certified nurse aide has resulted in such nurse aide being unable to practice with reasonable skill or that the practice of such nurse aide is a threat to the safety of such nurse aide's patients, the board may require such nurse aide to submit to a mental or physical examination by a physician designated by the board. Effective July 1, 2005 Page 6 of 12

9 (b) If such nurse aide fails to submit to such examination, absent a determination by the board that there is good cause for such failure, the board may summarily suspend such nurse aide's certification until such time as the nurse aide submits to the required examination. (3) Every person who applies to the board for certification as a nurse aide shall be deemed by virtue of such application to have given his consent to undergo a physical or mental examination at any time if the board so requests. Any request by the board to a nurse aide to submit to such an examination shall be in writing and shall contain the basis upon which the board determined that reasonable cause to believe the condition specified in paragraph (a) of subsection (2) of this section exists. (4) A certified nurse aide who has been requested to submit to a physical or mental examination may provide the board with information concerning such nurse aide's physical or mental condition from a physician of the nurse aide's own choice. The board may consider such information in conjunction with, but not in lieu of, testimony and information provided by the physician designated by the board to examine the nurse aide. (5) The results of any mental or physical examination requested by the board pursuant to this section shall not be used as evidence in any proceeding except a proceeding conducted pursuant to this article. The results of such examination shall not be deemed to be public records and shall not be made available to the public Disciplinary proceedings - hearing officers. (1) The board, through the department of regulatory agencies, may employ hearing officers to conduct hearings as provided by this article or to conduct hearings on any matter within the board's jurisdiction, upon such conditions and terms as the board determines to be appropriate. (2) A proceeding for discipline of a certified nurse aide may be commenced when the board has reasonable grounds to believe that a nurse aide certified by the board has committed acts which may violate the provisions of this article. (3) The license of a person certified by the board as a nurse aide may be revoked or such person may otherwise be disciplined upon written findings by the board that the licensee has committed acts that violate the provisions of this article. (4) Any certified nurse aide disciplined under subsection (3) of this section shall be notified by the board, by a certified letter to the most recent address provided to the board by the certified nurse aide, no later than thirty days following the date of the board's action, of the action taken, the specific charges giving rise to the action, and the certified nurse aide's right to request a hearing on the action taken. (5) (a) Within thirty days after notification is sent by the board, the certified nurse aide may file a written request with the board for a hearing on the action taken. Upon receipt of the request the board shall grant a hearing to the certified nurse aide. If the certified nurse aide fails to file a written request for a hearing within thirty days, the action of the board shall be final on that date. (b) (Deleted by amendment, L. 93, p. 1747, 7, effective July 1, 1993.) (6) The attendance of witnesses and the production of books, patient records, papers, and other pertinent documents at the hearing may be summoned by subpoenas issued by the board, which shall be served in the manner provided by the Colorado rules of civil procedure for service of subpoenas. (7) Disciplinary proceedings shall be conducted in the manner prescribed by article 4 of title 24, C.R.S., and the hearing and opportunity for review shall be conducted pursuant to said article by the board or a hearing officer at the board's discretion. (8) Failure of the certified aide to appear at the hearing without good cause shall be deemed a withdrawal of his or her request for a hearing, and the board's action shall be final on that date. Failure, without good cause, of the board to appear at the hearing shall be deemed cause to dismiss the proceeding. (9) (a) No previously issued certificate to engage in practice as a nurse aide shall be revoked or suspended except under the procedure set forth in this section, except in emergency situations as provided by section , C.R.S. (b) The denial of an application to renew an existing certificate shall be treated in all respects as a revocation. (10) (a) The board or an administrative law judge shall have the power to administer oaths, take affirmations of witnesses, and issue subpoenas to compel the attendance of witnesses and the production of all relevant papers, books, records, documentary evidence, and materials in any hearing, investigation, accusation, or other matter coming before the board. The board may appoint an administrative law judge Effective July 1, 2005 Page 7 of 12

10 pursuant to part 10 of article 30 of title 24, C.R.S., to take evidence and to make findings and report them to the board. The person providing documents shall prepare them from the original record and shall delete from the copy provided pursuant to the subpoena the name of the patient, but the patient shall be identified by a numbered code to be retained by the custodian of the records from which the copies were made. Upon certification of the custodian that the copies are true and complete except for the patient's name, they shall be deemed authentic, subject to the right to inspect the originals for the limited purpose of ascertaining the accuracy of the copies. No privilege of confidentiality shall exist with respect to such copies, and no liability shall lie against the board or the custodian or the custodian's authorized employee for furnishing or using such copies in accordance with this subsection (10). (b) Upon failure of any witness to comply with such subpoena or process, the district court of the county in which the subpoenaed person or licensee resides or conducts business, upon application by the board or director with notice to the subpoenaed person or licensee, may issue to the person or licensee an order requiring that person or licensee to appear before the board or director; to produce the relevant papers, books, records, documentary evidence, or materials if so ordered; or to give evidence touching the matter under investigation or in question. Failure to obey the order of the court may be punished by the court as a contempt of court. (11) Any member of the board, any member of the board's staff, any person acting as a witness or consultant to the board, any witness testifying in a proceeding authorized under this article, and any person who lodges a complaint pursuant to this article shall be immune from liability in any civil action brought against him or her for acts occurring while acting in his or her capacity as board member, staff, consultant, or witness, respectively, if such individual was acting in good faith within the scope of his or her respective capacity, made a reasonable effort to obtain the facts of the matter as to which he or she acted, and acted in the reasonable belief that the action taken by him or her was warranted by the facts. Any person participating in good faith in the making of a complaint or report or participating in any investigative or administrative proceeding pursuant to this article shall be immune from any criminal or civil liability that otherwise might result by reason of such participation. (12) An employer of a nurse aide shall report to the board any disciplinary action taken against the nurse aide or any resignation in lieu of a disciplinary action for conduct which constitutes a violation of this article. (13) Except when a decision to proceed with a disciplinary action has been agreed upon by a majority of the board or its designee and notice of formal complaint is drafted and served on the licensee by firstclass mail, any investigations, examinations, hearings, meetings, or any other proceedings of the board related to discipline that are conducted pursuant to the provisions of this section shall be exempt from the open records provisions of article 72 of title 24, C.R.S., requiring that the proceedings of the board be conducted publicly or that the minutes or records of the board with respect to action of the board taken pursuant to the provisions of this section be open to public inspection Surrender of certificate. (1) Prior to the initiation of an investigation or hearing, any certified nurse aide may surrender his certificate to practice as a nurse aide to the board. (2) Following the initiation of an investigation or hearing and upon a finding that to conduct such an investigation or hearing would not be in the public interest, the board may allow a certified nurse aide to surrender his certificate to practice. (3) The board shall not issue a certificate to a former holder of a certificate whose certificate has been surrendered unless a one-year waiting period has passed since the date of the surrender, the applicant has met the requirements of this article, has successfully repeated an approved education program, and has repeated and passed a competency evaluation. (4) The surrender of a certificate in accordance with this section removes all rights and privileges to practice as a nurse aide, including the right to apply for renewal of a certificate Judicial review. The court of appeals shall have initial jurisdiction to review all final actions and orders of the board that are subject to judicial review. Such proceedings shall be conducted in accordance with section (11), C.R.S Exclusions. Effective July 1, 2005 Page 8 of 12

11 (1) This article shall not be construed to affect or apply to: (a) The gratuitous care of friends or family members; (b) A person for hire who does not represent himself or herself as or hold himself or herself out to the public as a certified nurse aide. However, no person for hire who is not a nurse aide certified under this article shall perform the duties of or hold himself or herself out as being able to perform the full duties of a certified nurse aide. (c) Nursing assistance in the case of an emergency; (d) A person who is directly employed by a medical facility while acting within the scope and course of such employment for the first four months of such person's employment at such medical facility if such person is pursuing initial certification as a nurse aide. A person may utilize this exclusion only once in any twelve-month period. This exclusion shall not apply to any person who has allowed his or her certification to lapse, had his or her certification as a nurse aide suspended or revoked, or had his or her application for such certification denied. (e) Any person licensed, certified, or registered by the state of Colorado who is acting within the scope of such license, certificate, or registration; (f) Any person performing services pursuant to sections and (2) (k), C.R.S., and part 3 of article 1.5 of title 25, C.R.S Unlawful acts. (1) It is unlawful for any person: (a) On or after January 1, 1990, to practice in a medical facility as a nurse aide except as provided pursuant to this article; (b) To use any designation in connection with his name that tends to imply that he is a certified nurse aide unless he is so certified under this article; (c) To practice as a nurse aide during any period when his certificate has been suspended or revoked; (d) To sell or fraudulently obtain or furnish a certificate to practice as a nurse aide or to aid or abet therein. (2) Any person who violates the provisions of subsection (1) of this section commits a class 2 misdemeanor and shall be punished as provided in section , C.R.S., and any person committing a subsequent offense commits a class 6 felony and shall be punished as provided in section , C.R.S Injunctive proceedings. The board may apply for injunctive relief through the attorney general in any court of competent jurisdiction to enjoin any person who does not possess a current valid certificate as a nurse aide issued under the provisions of this article from committing any act declared to be unlawful under or prohibited by this article. Such injunctive proceedings shall be in addition to and not in lieu of all penalties and other remedies provided for in this article Repeal of article. This article is repealed, effective July 1, Prior to such repeal, the certification functions of the state board of nursing shall be reviewed as provided for in section , C.R.S. PART 2 DIRECT CARE PROVIDER CAREER PATH PILOT PROGRAM Short title. This part 2 shall be known and may be cited as the "Direct Care Provider Career Path Pilot Program" Legislative declaration. (1) The general assembly hereby finds that: (a) The population of Colorado, as well as the nation, is aging at an unprecedented rate; (b) The United States bureau of census estimates the proportion of citizens over sixty-five years of age will double from ten percent in 1995 to approximately twenty percent in 2025; Effective July 1, 2005 Page 9 of 12

12 (c) Meanwhile, nursing and entry-level health care staffing shortages for long-term care providers, hospitals, and other health care providers are already reaching a critical point in Colorado; (d) Colorado has an unemployment rate of less than five and seven-tenths percent and a competitive labor market in a generally strong economy; (e) As a result of these and other factors, the recruitment and retention of trained and capable direct care workers among health care providers is at a crisis state in Colorado; (f) The governor appointed a blue ribbon panel to study the workforce issues related to long-term care, which panel submitted an extensive and thorough report, dated June 25, 2001, identifying these issues and making recommendations to address the state's long-term care staffing shortage; and (g) Among the recommendations of the governor's blue ribbon panel on workforce issues in health care was the development of a demonstration proposal for a tiered certified nursing assistant position. (2) The general assembly therefore determines and declares that, in order to appropriately meet the long-term and other direct care needs of a growing population of vulnerable Coloradans now and in the future, to assist health care providers in attracting individuals to careers in direct care, and to increase employment satisfaction and retention among individuals working in the direct care field, it is appropriate and advisable to: (a) Develop and adopt a tiered paraprofessional direct care provider career path tailored to encourage individuals entering the labor market into this important and satisfying career and to better reward such individuals as their skill levels increase; (b) Enhance education and training opportunities in the direct care field and to increase accessibility to such education and training in both urban and rural settings, as well as improve outreach to individuals with language and other barriers to such education and training; and (c) Establish a collaborative environment among institutions of higher education, vocational education institutions, educators, individuals seeking entry-level employment, Colorado works participants, county departments of social services, Colorado work force investment programs, job-training professionals, and potential health care employers to improve communication among such stakeholders, and ultimately to place more individuals in and stabilize the field of direct care through the successful development and implementation of a tiered long-term health care paraprofessional career path Pilot program - authorization. (1) There is hereby created the direct care provider career path pilot program, referred to in this part 2 as the "pilot program", the purpose of which shall be to bring together, in a collaborative environment, institutions of higher education and other appropriate educators, individuals seeking entry-level employment including but not limited to Colorado works participants, county departments of social services, Colorado work force investment programs, job-training professionals, and potential employers in the subacute and long-term health care provider industry toward the achievement of the common goal of improved recruitment and retention of workers in the direct health care profession. The pilot program shall continue for a period of three years and shall be implemented in southwest Colorado. (2) It shall be the responsibility of the state board for community colleges and occupational education established pursuant to section , C.R.S., under the pilot program to coordinate communication and collaboration among interested stakeholders in the pilot program, including but not limited to the community colleges in southwest Colorado, the vocational education institutions in southwest Colorado, local work force investment boards in southwest Colorado, established pursuant to part 2 of article 71 of title 8, C.R.S., county departments of social services' Colorado works programs, individuals seeking entrylevel employment, Colorado works participants, and potential employers in the health care industry to achieve the common goal of improved recruitment and retention of paraprofessionals working in the longterm care field. (3) The board may coordinate efforts with a community-based multi-disciplinary stakeholder group in southwest Colorado that is interested in addressing similar issues as the pilot program, which group shall be referred to in this part 2 as the direct care advisory committee. The board may work cooperatively with the direct care advisory committee toward the development and implementation of the direct care provider career path pilot program. In developing and implementing the pilot program, the direct care advisory committee is encouraged to consider the factors listed in section (4) (Deleted by amendment, L. 2003, p. 959, 1, effective April 17, 2003.) Rule-making - training - education. Effective July 1, 2005 Page 10 of 12

13 (1) The board may promulgate rules to implement the direct care provider career path pilot program, which rules shall provide for a three-tiered certification for individuals performing the tasks of a nurse aide paraprofessional, which shall be defined by the tasks to be performed by the individual and the training or education of the individual. Prior to promulgating rules implementing the pilot program, the board is encouraged to consult with the parties identified in section (2) and (3). The three tiers of paraprofessional certification shall be for: (a) (Deleted by amendment, L. 2003, p. 959, 2, effective April 17, 2003.) (b) A certified nurse aide - level I, who is fully trained and in compliance with the provisions of part 1 of this article and all applicable regulations; (c) A certified nurse aide - level II, who is fully trained and in compliance with the provisions of part 1 of this article and all applicable regulations and who has advanced education and training specified by the board upon recommendations of the direct care advisory committee; and (d) A certified nurse aide - level III, who is fully trained and in compliance with the provisions of part 1 of this article and all applicable regulations and who meets mentor and preceptor standards and any other specialty or advanced training requirements specified by the board upon recommendations of the direct care advisory committee. (2) The board shall conduct the direct care provider career path pilot program in southwest Colorado. The board is authorized to determine, by rule, the geographic parameters of the pilot program within southwest Colorado. (3) The rules promulgated by the board to implement the pilot program shall specify the pilot program's requirements and restrictions, which shall include but shall not be limited to: (a) Defining the tasks to be performed by each paraprofessional certification level; (b) Defining the training and educational requirements for each paraprofessional certification level; (c) Providing for appropriate oversight of and accountability from individuals performing nursing assistant tasks under the pilot program; (d) Requiring a criminal history background check to be conducted and submitted with the individual's application for certification; (e) Restricting recertification, consistent with the provisions of part 1 of this article, of an individual whose certification has been revoked or surrendered; (f) Providing for a tiered application fee structure for pilot program applicants that is consistent with the paraprofessional certification tiers; (g) Providing for a disciplinary structure for pilot program participants that is consistent with the disciplinary provisions of part 1 of this article; and (h) Any other requirement or restriction, consistent with the provisions of part 1 of this article, that is necessary to implement the pilot program. (4) The board shall approve education programs in southwest Colorado for the education and training of individuals participating in the pilot program consistent with the board's duties under part 1 of this article. The board shall coordinate these education and training efforts with the state board for community colleges and occupational education established pursuant to section , C.R.S., and the local work force investment boards established pursuant to part 2 of article 71 of title 8, C.R.S Applicability. Nothing in this part 2 shall be construed to change or affect the regulation or certification of nurse aides as provided in part 1 of this article Report. (1) The direct care advisory committee, referred to in section (3), shall report, and the board shall forward the report, to the members of the health, environment, welfare, and institutions committees of the house of representatives and the senate of the general assembly, as well as to the governor, within two months after the completion of the pilot program, concerning the effectiveness of the pilot program in recruiting new entry-level workers into the long-term care profession and in retaining current and new long-term care workers through enhanced employment satisfaction. The report may include, but need not be limited to: (a) The number of persons participating in the pilot program; (b) The number of entry-level workers entering the direct care profession during the course of the pilot program and whether such persons are or were Colorado works participants or work force investment Effective July 1, 2005 Page 11 of 12

14 program participants, or whether they learned about the pilot program through an institution of higher education; (c) Changes that were instituted in the education and training of nurse aide paraprofessionals; and (d) Any other additional information that the board and the direct care advisory committee deem appropriate and informative Funding. Funding for certification under this pilot program shall be provided by federal medicaid and medicare programs in the same manner as established in section (6) Repeal of part. This part 2 is repealed, effective July 1, 2008, unless otherwise repealed pursuant to section Effective July 1, 2005 Page 12 of 12